Neuraxial anesthesia in a patient with anti-N-methyl-D-aspartate receptor encephalitis in pregnancy: management for cesarean delivery and oophorectomy

We describe the neuraxial anesthetic management of a 28-year-old primigravid patient with severe, treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis undergoing cesarean delivery. The presence of an ovarian teratoma was suspected although not confirmed by imaging. The severity of symptoms, ineffective immunotherapy and the need for chemotherapy necessitated cesarean delivery and resection of a suspected teratoma at 28 weeks estimated gestational age. A combined spinal-epidural technique was used. Delivery was uneventful, and a right oophorectomy was performed for a visible lesion that was later confirmed to be a mature cystic teratoma.